STOMA RECURRENCE AFTER LARYNGECTOMY - AN ANALYSIS OF RISK-FACTORS

Data from 130 patients who underwent total laryngectomy for squamous c ell carcinoma of the larynx were reviewed, Patients were treated eithe r by primary laryngectomy and planned postoperative radiotherapy or by primary radiotherapy and subsequent salvage laryngectomy. Patients wi th other treatment modalities and patients with positive margins of re section and laryngectomies for hypopharyngeal cancers were excluded fr om the study. The stomal recurrence rate with reference to several ris k factors, such as primary tumor stage, location of tumor, lymph node metastases, timing of tracheotomy, and presence of a postoperative pha ryngoperistomal fistula, was analyzed. The overall incidence of stomal recurrence was 10%. The treatment modality appeared to have an impact on subsequent stomal recurrence: stomal recurrence developed more oft en after salvage laryngectomy (18.4%) than after primary laryngectomy with planned postoperative radiation (4.8%). Advanced T stage, N stage , subglottic involvement, and preoperative tracheotomy are risk factor s for stomal recurrence only in patients with a primary laryngectomy. Stomal recurrence developed in only four patients after primary laryng ectomy with planned radiation. All four patients had more than one ris k factor: primary tumor stage T4 (four times), subglottic involvement (three times), and preoperative tracheotomy (three times). The presenc e of a postoperative pharyngoperistomal fistula likewise may represent a risk factor for the development of a stomal recurrence.